<?xml version="1.0"?>

<!--
SPDX-FileCopyrightText: 2008-2026 Luis Falcón <falcon@gnuhealth.org>
SPDX-FileCopyrightText: 2011-2026 GNU Solidario <health@gnusolidario.org>

SPDX-License-Identifier: GPL-3.0-or-later
-->

<form>
    <group col="6" colspan="4" id="insurance_header">
        <label name="number"/>
        <field name="number"/>
        <label name="party"/>
        <field name="party"/>
        <label name="insurance_type"/>
        <field name="insurance_type" widget="selection"/>
    </group>
    <newline/>
    <group col="6" colspan="4" id="insurance_plan">
        <label name="company"/>
        <field name="company"/>
        <label name="plan_id"/>
        <field name="plan_id"/>
        <label name="category"/>
        <field name="category"/>
    </group>
    <newline/>
    <label name="member_since"/>
    <field name="member_since"/>
    <label name="member_exp"/>
    <field name="member_exp"/>
    <label name="status"/>
    <field name="status"/>
    <newline/>
    <field name="notes" colspan="4"/>
</form>
